A Case of Asymptomatic Patient with Idiopathic Pulmonary Artery Aneurysm

An aneurysm of the pulmonary artery is a rare entity, but has a potentially fatal prognosis. We report a case of a 28 year-old asymptomatic woman, with an idiopathic pulmonary artery aneurysm. She was admitted to our hospital because of an abnormal bulging contour of the left hilum on chest X-ray. A computed tomographic scan and pulmonary angiography showed dilatation of the main and proximal left pulmonary arteries. She has a stable, non-progressive condition without treatment during the 8 month follow-up period.

The Relationship between Preceding RR Intervals and Peak Ejection Velocity of Left Ventricular Outflow in Atrial Fibrillation without Organic Heart Diseases

BACKGROUND AND OBJECTIVES: Cardiac performance is dependent on both the preceding RR interval (RR-1) and the prepreceding RR interval (RR-2) in atrial fibrillation (AF). We reported a new method for improving the relation between the two RR intervals and cardiac performance in AF of various causes. The aim of this study was to re-evaluate the method and its relationship in AF without organic heart disease. SUBJECTS AND METHODS: The beat to beat variation in the left ventricular outflow peak ejection velocity (Vpe) was measured by pulsed Doppler ultrasound in 28 consecutive patients with lone AF. The relations between the RR-2 and the Vpe were obtained before and after the exclusion of coordinates with the RR-1<0.5 second. The association of the Vpe with the RR-1 was adjusted by the RR-2 using an equation obtained from the relation between the RR-2 and the Vpe. RESULTS: The RR-2 was found to have a weak, negative, association with the Vpe. The mean squared correlation coefficient (r2) between the RR-2 and the Vpe was 0.14+/-0.13, which was improved to 0.23+/-0.21 (p=0.007) following the exclusion of coordinates with a RR-1<0.5 second. The RR-1 was positively associated with the Vpe. The mean r2 between the RR-1 and the Vpe was 0.55+/-0.15, which became stronger, at 0.68+/-0.12 (p<0.001), following adjustment with the RR-2. A multiple stepwise regression analysis revealed that the mean and standard deviation of the RR interval, and the duration of AF were independently associated with the modified r2 between the RR-2 and the Vpe. CONCLUSION: Simple modification could improve the relationship of both the RR-1 and the RR-2 with the cardiac performance in AF without organic heart disease, as with AF of various causes.

The Effect of Coronary Stenting on Ventricular Activation Time in Coronary Artery Disease

BACKGROUND AND OBJECTIVES: The ventricular activation time (VAT) is increased in both ventricular hypertrophy and bundle branch block. It is also known that the VAT is increased in myocardial ischemia due to the development of depolarization abnormality. However, little is known about the changes in the VAT on body surface electrocardiography following coronary stenting in patients with ischemic heart disease. The purpose of this study was to evaluate the clinical significance of VAT following coronary stenting by assessing the changes in the VAT during the 6 months following coronary stenting in patients with ischemic heart disease. SUBJECTS AND METHODS: The VAT was measured in 92 patients who had underdone coronary stenting due to of significant coronary artery stenosis on coronary angiography. The electrocardiography was recorded with a high paper speed at pre-stenting, immediate after and at 1 and 6 months after coronary stenting. RESULTS: The VAT was significantly decreased during the 6 month follow-up following coronary stenting (pre-stenting ; 45.9 +/-5.9 msec, immediate after stenting ; 38.5+/-2.7 msec, after 1 month ; 38.8+/-2.8 msec and after 6 months ; 38.8+/-2.5 msec, p<0.05). The VAT dispersion was significantly decreased during the 6 month follow-up following coronary stenting in the patients with one vessel disease (p<0.05), but not with two vessels disease. CONCLUSION: Coronary stenting significantly decreased the VAT during the 6 month follow-up. We would conclude that coronary stenting relieves depolarization abnormalities caused by myocardial ischemia, and improves the intraventricular conduction velocity. However, further studies are needed to assess the usefulness of VAT in evaluating myocardial ischemia.

Effect of long-term 3-hydroxy 3-methyl glutaryl CoA reductase inhibitor therapy on lipoprotein (a) concentration / 대한내과학회지

BACKGROUND: The effect of 3-hydroxy 3-methyl glutaryl CoA reductase inhibitor (statin) on the concentration of lipoprotein (a) [Lp(a)] is controversial. Most studies evaluated the effect of statin administered for less than 2 years. We were to analyze the effect of long-term treatment of statin on the concentration of Lp(a) retrospectively. METHODS: A total 93 cases were enrolled and divided into two groups; statin group (20 mg of lovastatin, n=33) and control group (n=60). Lp(a) and lipid profiles were measured before and after the medication for at least 2 years. RESULTS: Between two groups, there were no differences in baseline clinical variables and in biochemical parameters except total cholesterol and low density lipoprotein-cholesterol (LDL-C) levels. Mean duration of follow-up was similar between control and statin groups (58.7+/-15.0 vs. 54.7+/-16.4 months, p=0.24). Lp(a) levels did not change in both statin group (30.1+/-29.6 mg/dL vs. 28.2+/-23.1 mg/dL, p=0.89) and control group (p=0.49). The change of Lp(a) was not different between two groups (p=0.43). Statin was also ineffective in cases with Lp(a) level over 10 mg/dL. Total cholesterol and LDL-C levels decreased in statin group by 26.4% (p=0.000) and 40.5% (p=0.000) respectively. The elevation of HDL-C was similar between two groups. CONCLUSION: Long-term treatment of lovastatin did not modify Lp(a) level in retrospective study. To clarify the effect of statin precisely, prospective study might be needed.

Effect of long-term 3-hydroxy 3-methyl glutaryl CoA reductase inhibitor therapy on lipoprotein (a) concentration / 대한내과학회지

BACKGROUND: The effect of 3-hydroxy 3-methyl glutaryl CoA reductase inhibitor (statin) on the concentration of lipoprotein (a) [Lp(a)] is controversial. Most studies evaluated the effect of statin administered for less than 2 years. We were to analyze the effect of long-term treatment of statin on the concentration of Lp(a) retrospectively. METHODS: A total 93 cases were enrolled and divided into two groups; statin group (20 mg of lovastatin, n=33) and control group (n=60). Lp(a) and lipid profiles were measured before and after the medication for at least 2 years. RESULTS: Between two groups, there were no differences in baseline clinical variables and in biochemical parameters except total cholesterol and low density lipoprotein-cholesterol (LDL-C) levels. Mean duration of follow-up was similar between control and statin groups (58.7+/-15.0 vs. 54.7+/-16.4 months, p=0.24). Lp(a) levels did not change in both statin group (30.1+/-29.6 mg/dL vs. 28.2+/-23.1 mg/dL, p=0.89) and control group (p=0.49). The change of Lp(a) was not different between two groups (p=0.43). Statin was also ineffective in cases with Lp(a) level over 10 mg/dL. Total cholesterol and LDL-C levels decreased in statin group by 26.4% (p=0.000) and 40.5% (p=0.000) respectively. The elevation of HDL-C was similar between two groups. CONCLUSION: Long-term treatment of lovastatin did not modify Lp(a) level in retrospective study. To clarify the effect of statin precisely, prospective study might be needed.

The change in QT dispersion on treadmill exercise test after coronary stenting / 대한내과학회지

BACKGROUND: QT dispersion (QTd) represents inhomogeneous ventricular repolarization. Increased QTd has been reported to be associated with ischemic heart disease and sudden cardiac death. Successful percutaneous coronary angioplasty (PTCA) produces a favorable recovery of inhomogenous repolarization and reduces QTd. Although treadmill exercise test is commonly used for follow-up test after PTCA, limited data are available about QTd during treadmill test. The purpose of this study was to evaluate the change in QTd and determine its clinical role in follow-up treadmill exercise test after coronary stenting. METHODS: 41 patients with significant coronary artery disease underwent successful coronary stenting, while 46 patients were medically treated. Treadmill exercise test was performed to compare QTd between two groups as a follow-up test at 6 months after coronary stenting and medical therapy. Treadmill exercise test was recorded in pre-test, peak exercise, and recovery 2 minutes phase. QTd and corrected QT dispersion (QTcd) were measured in these ECGs using a digitizer. RESULTS: Coronary stenting significantly reduced QTd and QTcd at 6 months after coronary stenting. QTd and QTcd did not show significant difference between coronary stenting and medical therapy group at initial EKG before treatment. After coronary stenting, QTd and QTcd were significantly reduced than those of medical therapy group. And the changes in QTd and QTcd were more marked at peak exercise (28.2+/-11.9 and 39.3+/-16.2 msec in coronary stenting group vs 40.4+/-20.5 and 57.8+/-30.0 msec in medical therapy group). Lesion location and diseased vessel number were not associated with changes in QTd and QTcd. CONCLUSION: Coronary stenting reduced QTd and QTcd significantly in follow-up treadmill exercise test. Coronary stenting appears to be more effective to relieve myocardial ischemia and to improve inhomogenous ventricular repolarization than medical therapy. The measurement of QTcd during treadmill exercise test may be a useful index to evaluate myocardial ischemia after coronary stenting. Clinical relevance of these finding will require further study.

Heart Rate Recovery in Coronary Artery Disease and the Changes of Exercise Parameters after Coronary Stenting

BACKGROUND AND OBJECTIVES: The recovery of the normal heart rate immediately after exercise is a function of vagal reactivation. An attenuated heart rate recovery during the first minute after graded exercise is believed to be a marker of reduced parasympathetic activity and has been proven to be an independent predictor of overall mortality. However, the clinical significance of an abnormal heart rate recovery in coronary artery disease and the changes in the exercise parameters after coronary stenting have not been fully evaluated. Subjects and Methods: The study population included 53 patients with a significant coronary artery stenosis and 25 subjects with a normal coronary artery. All underwent a treadmill exercise test prior to coronary angiography. The differences in the heart rate recovery and the Duke treadmill score between two groups were investigated. After coronary stenting, changes in the exercise parameters were evaluated during the follow-up treadmill exercise test in 22 coronary artery disease patients. RESULTS: The frequencies of abnormal heart rate recovery (12% vs 38.3%, p=0.014) and a moderate to high risk Duke treadmill score (4% vs 21.3%, p=0.034) were significantly higher in the coronary artery disease group. The frequencies of these parameters were also significantly higher in the multivessel disease group than the single vessel disease group. After coronary stenting, most of the exercise parameters showed no significant changes but the Duke treadmill score improved significantly (p=0.038). CONCLUSION: The frequency of abnormal heart rate recovery was significantly higher in the coronary artery disease group. The Duke treadmill score was significantly improved and is thought to be a useful follow up parameter after coronary stenting.

Relationship between Exercise-induced Blood Pressure Response and Left Ventricular Hypertrophy in Patients with Hypertension

BACKGROUND: In hypertensive patients, who show abnormal blood pressure(BP) response during exercise, more excessive blood pressure response may occur in the daily life, and cause end organ damage. However, previous studies about exaggerated BP response during exercise were not enough to investigate its significance and role in left ventricular hypertrophy. The purpose of this study was to determine the relation between exaggerated BP response during exercise and left ventricular hypertrophy. METHODS: The treadmill exercise test and echocardiography were performed in 117 patients with hypertension. Sixty six patients showed normal BP response, fifty one patients showed exaggerated BP response. Exaggerated BP response was defined as elevation of peak exercise systolic BP over 210 mmHg or >10 mmHg elevation of peak exercise diastolic BP from baseline. The correlation between BP response and left ventricular mass index were evaluated in two groups. RESULT: The results were as follows; 1. The peak systolic and diastolic BP were significantly higher in patients with exaggerated BP response than that in patients with normal BP response (p<0.05). 2. There was weakly significant relation between peak exercise systolic BP and left ventricular hypertrophy, but diastolic BP showed no significant correlation with left ventricular hypertrophy. 3. The left ventricular mass index was significantly increased in patients with exaggerated BP response (normal BP response: 12025 gm/m2, exaggerated BP response: 16946 gm/m2 , p=0.04). CONCLUSION: These results indicate that, as compared with resting BP, exercise BP response seems to be important in the treatment of hypertension and more strict blood pressure control may be needed in hypertensive patients with exaggerated BP response. Further study is needed to understand the significance of exaggerated BP response in hypertension.

The change in phospholipase C-gamma1 expression following balloon injury to the rat carotid artery / 대한내과학회지

BACKGROUND: While inositol phospholipid-specific phospholipase C (PLC) plays a central role in signal transduction pathways, little is known about its role in the vascular response to injury. Recent studies have shown that phospholipase C-gamma1 (PLC-gamma1) is required for PDGF-induced DNA synthesis and angiotensin II signaling. This study was undertaken to determine the potential involvement of PLC-gamma1 in the in vivo response to vascular injury. METHODS: Vascular injury was achieved in the left common carotid artery of six-month-old male Wistar rats. The expression of PLC-gamma1 was evaluated at serial time points by immunohistochemistry and Western blot analysis following balloon de-endothelialization of the rat carotid artery. RESULTS: In the denuded carotid artery at 1 week, the neointima became thicker in a symmetrical manner with respect to the long axis. A strong expression of PLC-gamma1 at one week after injury was seen primarily in the thin layers of neointima. This increased immunoreactivity of PLC-gamma1 persisted at 2-3 weeks after injury, coinciding with the time when neointima gains of its mass. At 4 weeks after injury, staining intensity slightly declined but levels remained elevated. As determined by Western blot analysis, the amount of PLC-gamma1 was about 3-fold higher at 3 weeks after injury compared to uninjured vessels (p<0.01). CONCLUSION: These results suggest that the amplification of traffic within signal transduction pathways involving PLC-gamma1 occurs and may play a significant role in neointima formation following arterial injury.